Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Do Patients Value Nurse Prescribing?

Neil Johnston

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Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

A recent article in the British Journal of Dermatology (BJD) explored the issue of patient satisfaction and efficiency of nurse prescribing in dermatology services in the UK.
Dermatology has been one of the disease states that pharmacists have been involved in as “counter prescribers” over many years.
Nurse prescribing in this disease state is thus directly competitive and is delivered with some major differences when conducted in Australia – Medicare subsidises the consulting fee and the actual service is performed in more private and professional surrounds.
The BJD asserts that “skin disease can have a huge impact on quality of life for sufferers and their families. Nurses have an important role in the delivery of specialist dermatology services, and prescribing enhances the care they provide. The views of dermatology patients about nurse prescribing are unknown.”

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To identify patient views semi-structured interviews were undertaken with a consecutive sample of 42 patients with acne, psoriasis or eczema who attended the clinics of seven dermatology specialist nurse prescribers.
Primary and secondary care clinics were included to reflect settings in which nurses typically prescribe for patients within specialist dermatology services in England.
Interviews addressed the effects of nurse prescribing on care, patient’s medicine regime, involvement in treatment decisions and concordance, and influences on medicine taking.

After reviewing the results of the 42 patient interviews it was found that patients believed that nurse prescribing improved access to, and efficiency of, dermatology services.
Great value was placed on telephone contact with nurses, and local access.
Information exchange and involvement in treatment decisions ensured that treatment plans were appropriate and motivated adherence.
Nurses’ specialist knowledge, interactive and caring consultation style, and continuity of care improved confidence in the nurse and treatment concordance.

The service provided by UK nurses was more comprehensive than that currently provided by Australian pharmacists, in that follow up and interaction was continued by telephone interview after the first consultation.
Under the current pharmacy “counter prescribing” model this type of interaction does not occur.
Instead, it is left to the patient to follow up with their prescribing pharmacist if they have any further concerns, or a need for amplified information.
Thus, the nurse treatment plan win hands down.

i2P has been warning for over a decade that nurses (and GP’s) represented a greater competitive threat to pharmacy than your local Colesworth supermarket.
The competition they are currently providing is the result of a complacent and divided pharmacy leadership.
i2P has also warned that unless a "pharmacy in the home" service was established, pharmacy would have little ability to provide services to Australia's rapidly ageing population as well as compete against established professionals (community nurses).
In this month's Medical Journal of Australia Insight Blog Rollo Manning comments that the PBS has become little more than a small business support prop. I tend to agree with him as reliance for nearly 80% of a pharmacy practice is PBS related.
What happens when pharmacies have to tender for PBS contracts as Rollo asserts should now happen?
Pharmacies are very vulnerable and will have no alternative except to offer health consumers except a revamped counter prescribing model that is of high quality, already proven and accepted, but in great need of new investment (people and money).
That will generate its own flow of internal prescribing and retail activity that will partly offset declines in PBS revenues.

What does it take to kick-start pharmacy leaders into action and stop squandering all of our professional (and business) future?
 This has a particular impact on emerging young pharmacists who are trying to find employment and contribute to their chosen profession.
It is one thing to say that they must “sell” themselves, it is another where current pharmacists have enjoyed the bountiful years but have left nothing for the next generation.
How unprofessional!

The BJD concluded that “nurse prescribing can increase the efficiency of dermatology services. Patients experienced active involvement in decisions about their treatment which in turn contributed to concordance and adherence to treatment regimes.
This study has important implications for maximising resource use and improving access to, and quality of care, in dermatology specialist services.”

Unless current pharmacy owners take steps to employ a practice pharmacist to take charge of and enhance what have been traditional pharmacy services, pharmacy market shares for disease state services will rapidly decline.
Forget about declining PBS margins and the supposed high cost of a practice pharmacist -  get involved immediately.
And if you are looking for a good resource, try recruiting a senior pharmacist part-time who is semi-retired and has the communication skills and the experience to flesh out the role.
Not only will that plug the leaks rapidly being exploited by nurses, but it will create a mentor able to train emerging young pharmacists before they leave the profession for greener pastures.

Will it cost or will it pay?

Better you decide now, and if you decide to begin a formal service, document the evidence for better remuneration – another major pharmacy failure.

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